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Taking or rejecting reasons for repeat c-birth

post #1 of 8
Thread Starter 
Hey there-
To answer the question, I don't know if I'm pregnant, but really hope so!!!

I had a c-b in September, 2002 because ds was transverse breech with his umbilical cord wrapped tightly 2x around his neck. Everyone said he would have hanged himself during the first hard contractions and and then he would have likely ripped the placenta off while he was lying stuck and strangled in my birth canal thus causing me to either lose a ton of blood or actually bleed to death. Lovely scenario. So I'm happy that we 2 cheated Uncle Darwin of part of the natural mother-infant mortality rate.

Anyway, I'd like to have a VBACwith the next baby, and my gyno says why not? since my scar has healed nicely and the c-b was done for reasons other than any anatomical flaw of mine. He said that the rate of successful VBAC in this country is around 50%.

So the question is - especially for all you doulas, midwives and doctors out there:

If I'm in a labor & delivery room and they recommend another c-b, what reasons for it would be justified, or when is it still appropriate to refuse the surgery?

And how do you psychologically prepare yourself for a "real" labor and at the same time for the possibility of not having it?
post #2 of 8
If I'm in a labor & delivery room and they recommend another c-b, what reasons for it would be justified, or when is it still appropriate to refuse the surgery?
Well, I'll take a stab at this, and I'm sure you'll get other valuable input as well. If I were in a L & D room and the powers that be recommended a c-section, I'd be willing to go along with it IF the fetal heart rate was having decelerations and position change was not altering that (although I'd also do some research on decels ahead of time so I'd know what to look for), if my gut told me to (and that's assuming that I'd have the focus to read my gut instinct at a time like that), if the cord was coming out first, if there was seperation of the placenta (I'm drawing a blank on the technical term), the baby was really and truly stuck and a variety of positions had been tried. Those are the main ones that come to mind right now.

I would be really wary of c-section recommendations due to failure to progress at the almighty 1cm per hour rule which is such a crock to begin with. I'd also be wary of the "your water's been broken for too long and the baby has to be born within x number of hours". If my water broke and I didn't go into labor right away, I'd be sure nobody had their hands in my vagina for starters. I'd also be wary of the doc who's got somewhere to be at a certain time (although that's usually not publicly announced), and the doc who says you need a c-section for no other reason than "you've been in labor too long" . I'd also refuse to have a c/s if labor stalled and baby was doing fine. I'd try to get some sleep.

If I were really wanting to avoid a c/s (and again this are my personal feelings, not making a judgement on anyone with different thoughts/ideas/perspectives), I'd avoid the hospital like the plague. If I had to be at the hospital, I'd avoid induction, premature rupture of membranes, pitocin, and epidurals. I'd move around as much as possible, and I'd hire the best darn doula available. Someone really good at encouraging me, as well as willing to back me up with hospital staff. I'd also do research out the wazoo so if/when a nurse/doc tried to talk me into interventions or pulled the "dead baby card", I'd know where I stood and wouldn't be quite as vulnerable to their fear mongering.

So there you have my $.02 and then some

post #3 of 8
Not a midwife, just a two sections, then 3 vbacs mom, so I've obviously done my homework, hope I qualify to answer.

My last birth was almost a year ago. Went with the cnms at hospital to save $. Big mistake. But anyway...

I was "stuck" at 9 cm for 7 hours, with fht bottoming out in any position other than on all fours. Meconium appeared a couple of hours into this. Obviously, "they," including the doc they called in, were ready to roll to the OR. I was NOT.

Every time they mentioned the OR was ready for me, I countered. "Baby's hr ok on all fours? No thanks to section."
"Meconium now? Is it thick? Not too thick? No surgery."

Over two hours of pushing (remember, baby #5.) Of course, they put me on my back for this, the very position that caused SERIOUS decels. Turned out the cord was wrapped around Kegan's neck twice, very tightly.

That's my story. In retrospect, I wish I'd had a doula. It was very difficult to be always consious of details, and have to be cognizant and fight for myself, when I should have been off in "laborland." I believe that had a lot to do with being at 9cm for so long. I couldn't just "let go" like I should have.

Almost anyone else would have been whisked off to surgery.

I guess, to answer your question, the only situation I can think of that I would agree to a cesarean would be a placental abruption. Of course, even with surgery, there are no guarantees for baby's outcome in that situation.

I'm not really a new member, just a very old member, recycled.
post #4 of 8
I hope this hasn't been posted three times now!

I tried to edit to say that it's hard to talk during pushing, let alone after hours of fighting, and during forced pushing.

I just couldn't fight any longer on the details.
post #5 of 8
You gotta just do your homework. Read all the studies about the risks of any procedure, and the risks of refusing those procedures. Make up your own mind ahead of time what you will do given any situation and given your own unique circumstances.
For my vbac, I knew that I had to stay away from the hospital unless either baby or myself was in life-threatening danger.
So that's my answer - if there is an iminent risk of death to either baby or mother, c/s ok. If not, refuse. But that's where your education comes in, because they will (and even my wonderful, supportive ob did this) try to scare you and tell you that your baby will die if you don't do this or that or whatever. Don't take their word for it, read the literature available and make up your own mind.

That 50% vbac success rate sounds a bit high to me, but I also think the 26% c/s rate is way way too high anyway!
My midwives have a 98% vbac success rate and a c/s rate of less than 2% - that's why I went to see them instead of the cruddy hospital.
post #6 of 8
Just wanted to add, that from what I have read if you are eligible for VBAC your chances of V are THE SAME as a first time mom. So, check out the c-section rate of the hospital you are going to and the doctor you are seeing--- that will tell you the best about your individual chances.
post #7 of 8
Thread Starter 


Where can I get reliable info about different birth scenarios and the risks or benefits of interventions? The best sources for me would be online, as I don't live in the U.S. In the Czech Republic, the culture of birth differers from America's in several ways:

1) There are no doulas
2) Midwives are called "birth assistants" and do not do home births. They are pretty much like the hospital nurses back in the States. Although some of them advocate and teach classes in natural birth, if the doctor on the floor wants to intervene they won't stand in his/her way. The few brave souls who give birth at home are assisted only by their partners.
4) Most doctors are accustomed to being gods. Only 15 years ago (before the Velvet Revolution that overthrew the Communist regime) you could be jailed or committed to an insane asylum for going against a doctor's orders. The laws have changed but the mentality hasn't. (That said, some doctors are decent people and understand SOME of the demands women are starting to make in WESTERN COUNTRIES. Slowly these things are trickling into Czech society, but we will remain a few decades behind for some years to come, I fear.)
5) On the positive side, the first-time c-b rate is very low here. At the hospital where I gave birth it is 11%!!! However, my ob said that the VBAC rate is 50%.

Well, thanks for any sources you can pass along!
post #8 of 8
I have some links here.

Try the Gentlebirth website and Midwifery Today, either of those would be a good starting point. I didn't realize you lived in the Czech Republic. Hope you can find information to help you!
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